ETHICAL ISSUES REGARDING

HUMAN CLONING: A NURSING

PERSPECTIVE

Leyla Dinç

Key words: human cloning; nursing; nursing ethics; reproductive cloning

Advances in cloning technology and successful cloning experiments in animals have

raised concerns about the possibility of human cloning in recent years. Despite many
objections, this is not only a possibility but also a reality. Human cloning is a scientific
revolution. However, it also introduces the potential for physical and psychosocial harm
to human beings. From this point of view, it raises profound ethical, social and health
related concerns. Human cloning would have an impact on the practice of nursing
because it could result in the creation of new physiological and psychosocial conditions
that would require nursing care. The nursing profession must therefore evaluate the ethics
of human cloning, in particular the potential role of nurses.
This article reviews the ethical considerations of reproductive human cloning, discusses
the main reasons for concern, and reflects a nursing perspective regarding this issue.

Introduction
Advances in genetics and biotechnology have created previously unforeseen
possibilities, one of which is cloning technology. With its development, success-
ful cloning has been reported in sheep,1 calves,2 mice,3 monkeys,4 pigs5 and
rabbits6 by using a variety of somatic cell nuclear donors. Animal cloning has
raised concerns in recent years about the possibility of human cloning. Many orga-
nizations, such as the World Health Organization 7 and the European Parliament 8
have expressed the opinion that human cloning is ethically unacceptable and have
called for a ban on such research. In the USA, the National Bioethics Advisory
Commission recommended a moratorium on cloning children through somatic
cell nuclear transfer.9 However, despite these objections, it is not only a possibil-
ity but also a reality now.
Scientists working in advanced cell technology have announced that they have
cloned an early human embryo from an adult cumulus cell nucleus. According
to a website accessed on 12 May 2002, the furthest that any cloned human embryo

Address for correspondence: Leyla Dinç, Hacettepe University School of Nursing, 06100
Ankara, Turkey. E-mail: leylad@hacettepe.edu.tr

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 Ethical issues regarding human cloning 239

has developed is to ‘six cells’.10 This claim is controversial and has drawn criti-
cism from many researchers. On the other hand, according to Gulf News on 3 April
2002, Dr Antinori claimed that he had successfully implanted a cloned embryo
into a woman, and that she was eight weeks pregnant. 11 These announcements
have increased concerns and the world-wide public reaction against human
cloning. It is likely that there will be more attempts to clone human beings.
Questions are raised in this article to help readers to relate the text to ethics.
These questions are not necessarily answered, nor are there necessarily any
answers (yet).

What is cloning?
Cloning is the production of one or more individual plants or animals that are
genetically identical to an original individual. It has been used for centuries in
plants and insects by using various techniques. However, mammalian cloning is
a very recent development. For about 50 years, attempts were made to clone
mammals; however Dolly the sheep was the first success.
In reproductive cloning, two methods have been used: embryo splitting and
somatic cell nuclear transfer. In this article, the term ‘cloning’ refers to the pro-
duction of genetically identical organisms via somatic cell nuclear transfer, a tech-
nique that involves removing the nucleus of an unfertilized egg cell, replacing it
with material from the nucleus of a somatic cell (i.e. skin or cumulus cell) and
stimulating this cell to begin to divide.9 The nucleus of the somatic cell provides
the genetic information, while the oocyte provides the nutrients and mitochon-
dria that are necessary for the development of an embryo.
There are two distinct types of human cloning using somatic cell nuclear
transfer: reproductive and therapeutic. The objective of human reproductive
cloning is to produce a child who would be genetically identical to another indi-
vidual. The objective of therapeutic cloning is to provide compatible tissues and
organs for replacement therapy.12 The distinction between the two types is that,
in reproductive cloning the transnuclear egg or reconstituted zygote is implanted
into a woman’s uterus, whereas, in cloning for therapeutic purposes the transnu-
clear egg will form an in-vitro culture from which stem cells can be extracted. The
harvesting of stem cells includes the destruction of the embryo at the blastocyst
stage.13 Reproductive cloning can be used to help sterile individuals who cannot
have children in the natural way, and therapeutic cloning promises significant
benefits because organ supply for transplantation is limited and recipients need
to be given immunosuppressive drugs to avoid rejection of transplanted organs
because of genetic differences. It also offers the possibility of learning more about
renewed activity of damaged cells and the opportunity to cure diseases such as
Alzheimer ’s, Parkinson’s and degenerative neuromuscular and joint diseases.13–15
Although there are promising benefits of therapeutic cloning for the well-being
of others, there is also the potential for intentional use of the embryos.
Krauthammer has noted that cloning embryos only for research or therapeutic
purposes could not prevent their reproductive use; one or more of these cloned
embryos could be implanted in a woman.16
From the viewpoint of science and technology, cloning can be regarded as a

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revolution and an extraordinary achievement, but from the viewpoint of
humanity and ethics, it raises profound ethical, social and health concerns.
l How could human cloning affect the cloned individual, the family, society and
the future of human beings?
l What are the main concerns regarding human cloning?
l What are the moral costs of human cloning?
l Why should nurses be concerned about human cloning?
The aim here is to provide an overview of the ethical considerations of repro-
ductive human cloning and to reflect a nursing perspective on this issue.

Ethical considerations of human cloning

Potential physical harms
The Council on Ethical and Judicial Affairs (CEJA) of the American Medical
Association points out in its 1998 report9 that ‘somatic cell nuclear transfer has
not yet been refined and its long-term safety has not yet been proven. The risk
of producing individuals with developmental anomalies is serious’. The
International Council of Nurses (ICN) also considers human cloning to be both
useful and damaging for human health. 17
l Cloning can introduce potential physical harms for humans. Should we be
worried?
Animal cloning experiments using somatic cell nuclear transfer demonstrated
that the efficiency of reconstituted eggs developing to generate a single live birth
is currently very low. In cloning Dolly the sheep, 277 eggs were used, 29 started
to divide, nine induced pregnancy, but only one survived to term.15 In another
study, 276 nuclear transfers were produced from fibroblasts and, out of 28
embryos transferred to 11 cows, three healthy calves were generated. 2 Researchers
concerned with other animal cloning experiments have reported similar
findings.5,6 The highest efficiency rate was reported by Wakayama et al. (2.8%).3
The possible reasons for inefficiencies are suggested by Polejaeva et al.5 to be:
laboratory to laboratory variation, oocyte source and quality, methods of embryo
culture, donor cell type, failure to reprogramme the transplanted nucleus ade-
quately, and the failure of artificial methods of activation to emulate reproducibly
the membrane-mediated events that accompany fertilization. Moorgate has
argued that further elucidation of the molecular mechanisms involved during the
processes of embryogenesis, and the careful tailoring of subsequently developed
culture conditions and manipulation strategies, can improve the efficiency and
success rate.18 However, at present, this inefficiency is a problem and large
numbers of human eggs or many embryos would be needed to produce a child.
The second concern is the developmental abnormalities that have been
observed in various mammals cloned by somatic nuclear transfer. The large
offspring syndrome has been a common problem occurring in several live-
birth animals. In this syndrome, the offspring is born oversized with dispropor-
tionally large internal organs, and often has respiratory, circulatory and other

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 Ethical issues regarding human cloning 241

problems.12,19 In the experiment reported by Cibelli et al.,2 one of the cloned cows
aborted at day 249, earlier than the normal gestation for a cow, which is about
280 days. The aborted fetus was oversized, the lung lobes were oedematous, and
the right heart ventricle was enlarged. Jaenish and Wilmut have postulated 19 that
the most likely explanation for inefficiencies and developmental abnormalities
may be the failure in the genomic reprogramming that occurs within minutes or
hours of nuclear cloning, and which could lead in turn to dysregulation of gene
expression. Some of the developmental abnormalities may be related to incom-
patibility between nuclear and cytoplasmic genes. In the great majority of sexual
organisms, mitochondria are located in the cytoplasm and the mitochondrial
genome is usually inherited through the maternal parent.14,20 Mitochondrial
function is normally controlled by a combination of nuclear and mitochondrial
genes. In general, this process is consistent, but sometimes conflict occurs. Such
potential conflict is probably partly to blame for the poor rates of success in
cloning animals by nuclear transfer.20
There is concern that the same abnormalities would probably occur after human
cloning. In contrast, Killian et al.21 reported that the large offspring syndrome
appears to be correlated with an incorrect imprint of the IGF2R (insulin-like
growth factor II receptor) gene, but this gene is not imprinted in humans, sug-
gesting that fetal overgrowth would not be predicted to occur if humans were
cloned. Rhesus monkeys that have been cloned by nuclear transfer of embryonic
nuclei have shown no developmental or physiological abnormalities. 22 This
evidence supports the hypothesis of Killian et al.21 However, in order to accept
that human clones would not be subject to developmental abnormalities, further
scientific studies are needed to verify the hypothesis. At present, the indications
from animal cloning experiments are that developmental abnormalities would
probably occur in human cloning.
l What could be done if the fetus is identified as having a developmental abnor-
mality when he or she comes close to term?
It could be argued, correctly, that as the cloned embryo would be genetically
identical to the donor adult cell, then presumably the adult would have under-
gone genetic screening prior to the procedure. However, there are no methods
available now or likely to be in the foreseeable future for examining the overall
epigenetic state of the nuclear genome.19 On the other hand, because the mito-
chondrial genome of the clone would differ from that of the nuclear parent, the
source of the oocyte cell should also undergo genetic screening. Over 30 differ-
ent genetic loci have been found in mitochondrial DNA, mutations of which cause
discrete human diseases in various tissues and organ systems, ranging in effect
on a scale from bothersome to lethal in any given individual.23 Roberts recom-
mends that the cloning procedure could be used as an alternative method to elim-
inate the possibility of recurrence of mitochondrial disease in affected families, by
using egg donation from the paternal side of the family.23 He also points out that,
even in apparently familial cases, no prenatal diagnostic tests can determine
whether mitochondrial disease will occur postnatally; the prediction of a critical
proportion of abnormal mitochondria in a given tissue is not possible. A recent
editorial in the The Lancet drew attention to an important point that is relevant to
this subject:

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With somatic cell nuclear transfer, the donor nucleus has to be reprogrammed in a very
short time and in a very different context from that of maturation of the sperm or ovum.
This makes the process error prone. Current methods of preimplantation or prenatal
genetic screening pick up chromosomal aberrations and single-gene defects but not epi-
genetic dysregulation. Nor can current methods of prenatal imaging pick up micro-
scopic effects such as the thickened pulmonary arterioles that have been associated with
respiratory distress. 24
The aim of this article is not to assess prenatal or preimplantation genetic tests,
but the above statements indicate that there is still insufficient data on how genetic
tests truly predict risk.
The possibility of creating animal/human hybrids through the use of cloning
techniques has also the potential for physical harms. Researchers in Australia
implanted a cell containing human DNA into a pig in 1999, but terminated the
embryo after it had developed for 32 days.25 They did not explain why this was
done. However, the possible reason may have been the ethical and political
concerns they raised with this experiment. Recently, Chinese scientists removed
the chromosomes from rabbit eggs and replaced them with the nuclei of skin cells
from a seven-year-old boy. They revealed that they hope to use the resulting
embryos to generate embryonic stem cells for research into regenerative
medicine. 26 The purpose of such research may be therapeutic for human health.
However, combining human genetic material with that of other species has the
potential to create a new life. If such a creation survives, it would probably be
more human than animal, because of the nuclear genome. The creation of hybrid
individuals that may survive violates respect for human life. It could also be dan-
gerous to human health because of the potential risk for transmission of infec-
tious agents from animals, or because of other unknown physical harms. Humans
and chimpanzees are as closely related genetically as some species that can be
crossed.
l Should crossing chimpanzees and humans proceed?
l What reasons could be foreseen why this should be done?
l How valid could such reasons be?
l Who would benefit most?
l What will be the problems with animal mitochondria being used in a human
cloned being?
l What will be the new creation?
l Will this be a chimpanzee that is genetically superior or a genetically inferior
human being?
l Do any human cloning benefits outweigh the risks?
I am deeply concerned about how far these experiments could go.
The potential for human cloning to cause physical harms contradicts the fun-
damental ethical principle of nonmaleficence. Nonmaleficence derives from one
of the most traditional of medical guidelines that goes back to the time of
Hippocrates: ‘primum non nocere’ (i.e. first of all, do no harm). This principle
expresses the concept that health care professionals have a duty to protect patients
from harm. It also requires not harming any possible human beings. Often, the
principle of nonmaleficence is combined with the principle of beneficence,
described as ‘to do good’, or ‘the duty to care’. However, sometimes there may

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be tension between these two principles. 27 For instance, chemotherapy has serious
adverse effects. In such cases, the principle of nonmaleficence is not necessarily
violated if a proper balance of benefits exists; the harm is not directly intended,
but is rather an unfortunate side-effect of attempts to improve a person’s health.
In accordance with this view, Savulescu has argued 28 that, in the case of embry-
onic stem cell research, the enormous potential to save people’s lives and to
improve their quality of life outweighs the wrong of the destruction of some
embryos. In reproductive human cloning, the benefit of having a genetically iden-
tical child weighed against the ethical cost of potential developmental abnormal-
ities and/or unknown physical harms must be carefully evaluated. In addition,
even though it is not so problematic as in therapeutic cloning, the status of surplus
embryos in reproductive cloning is also controversial, because this procedure
creates the possibility of more embryos being produced than are needed for
implantation. After implantation of one to four of these cloned embryos, the
surplus may be considered for cryostorage for subsequent use or they may be
used for research purposes. If they are not used at all, then they would be
destroyed. Even if all embryos are implanted into a woman, embryo reduction
may be performed for the sake of the healthy development of the others. The
question arises: What is the moral status of a human embryo? This raises critical
questions:
l When does life become human and have a moral value in the continuum
between a single cell and an adult person?
l Can this early embryo be classified as an individual and worthy of respect?
The literature concerning the moral status of embryos reveals different view-
points. The general agreement is that an embryo is radically different from a
sperm or an egg, or any other cell in the body; it contains the DNA, the complete
human genome. That is, its potential is to develop into a human being. Thus, the
most widely agreed viewpoint holds that a human embryo is a potent symbol of
human life that deserves profound respect.13,29–31 For some, individuality or per-
sonhood may be considered as a basis for determination of the moral status of a
human embryo. On this account, a pre-implantation embryo does not have per-
sonhood until the process of restriction is completed; that is, until cells become
committed to becoming a particular part of the body, the pre-implantation embryo
is divisible into parts, each of which can become a whole. After three weeks, the
embryo becomes indivisible and, consequently, an individual. In the meantime,
at around day 14 the primitive streak (precursor of the brain and central nervous
system) develops. Prior to this point in time, an embryo can undergo twinning. 31
According to McMahon,32 entities do not begin to exist until around the seventh
month of fetal gestation. Therefore, to kill a clone prior to that time would prevent
only one of us from existing. Viewpoints about the moral status of a human
embryo vary widely and there may be no precise consensus. What is clear is that
the pre-implantation embryo is living; it possesses the human genome and has
value.
The value attributed to a human embryo or fetus determines whether it should
be respected as an individual or not. Respect for persons means treating indi-
viduals as persons with rights.27 If we consider a human embryo as a potential
human being and worthy of respect, than we should recognize its right to life. In

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the same way, a fetus has a right to life, and a right not to be harmed. From this
perspective it is wrong to destroy human embryos and it is unethical to expose
a fetus to potential abnormalities. On the other hand, respect for persons means
further respecting the autonomy of individuals and honouring their rationality.27
To be autonomous, an individual must manifest decision making and rationality.
However, neither a pre-implantation embryo nor a fetus has decision-making
capacity and rationality; thus they are not autonomous beings.
l Does it mean that they are not worthy of respect?
l If so, what about our responsibilities and obligations toward other human
beings who are incapable of exercising their rights (i.e. fetuses, people with
severe learning difficulties, children who are disabled and/or people with
severe mental illness)?
l What about hybrids?
l Can a hybrid be respected?
l Would it not simply have ‘exhibition status’?
l Could a human/animal hybrid respect itself?
l How would such a being function as the only one of its kind?
l What does this say about community?
l What do nurses have to contribute to this debate?
l Can a specific nursing voice be realistic?

Potential psychological harms

The CEJA notes in its report that human cloning has the potential to introduce
psychosocial harms to individuals. 9 The ICN also considers that human cloning
violates the right to one’s unique genetic identity and dignity.17
Human reproductive cloning would bring the genetic inheritance of some
future children within present human control. Owing to the nature of cloning, the
genetic predisposition and conditions of a cloned individual would be known,
and knowledge of a child’s genetic predisposition could lead to misuse of his or
her genetic information. Genetic information of a cloned individual can be
obtained by physicians, researchers or other health care providers, and from the
patient record systems of hospitals or private clinics where this procedure is per-
formed. Inadvertent or malicious disclosure of genetic information by unquali-
fied persons would not only violate confidentiality and privacy, it could also lead
to discrimination in health care insurance or in the employment status of indi-
viduals.
Having insight into personal potential may cause pressures on and expectations
from the cloned child, even more than those generally experienced by children.9
These pressures and expectations could limit that child’s freedom or autonomy.
Some believe that human cloning would be likely to have important effects on
people’s sense of self or identity: on their intrinsic value as persons, or on their
sense of freedom or autonomy in constructing their life. 9,33 When the child learns
that he or she is a cloned individual, this information may lead to personal con-
fusion. Knowledge of being cloned or being created in an ‘unnatural’ way could
be perceived as stigmatizing, evoking strong emotions such as denial, a sense of
not being himself or herself, and anger towards the parents. Such emotions could

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 Ethical issues regarding human cloning 245

lead to identity crises and low self-esteem. On the other hand, knowledge of being
cloned, especially with a favourable genetic inheritance, could be perceived as
superiority and could lead to over-esteem.
Brock has argued 33 that cloning can undermine only our genetic uniqueness,
not our full individuality, because the full identity, individuality or self of a person
is determined by much more than the genome. He also noted that only a mistaken
belief in genetic determinism supports the view that a clone’s freedom or
autonomy to construct his or her own life would be undermined by cloning.
Eisenberg stated 34 that the clone would not be the same person as the cloned indi-
vidual because an individual’s identity is constituted by both her or his genome
and the interactions of genes over time with the environment, including personal
choices made, and important relationships formed with other persons. The envi-
ronment is not static; it is dynamic and it is altered by a variety of circumstances.
Even if the environmental conditions for a cloned infant were identical to those
of his or her progenitor, the future is not predestined.
l So far, clones have been envisaged for utilitarian purposes (to ‘replace’ a loved
child or to use organs for specific individuals); if the environment influences
the clone independently of the genetic make-up, is it still useful to create
clones?

The impact of human cloning on familial relationships and society

The value of a human embryo influences decisions and actions about how to treat
it. If we consider a human embryo only as a means for our purposes, then the
consequences would be unpredictable, in particular for society. Embryos could be
deliberately produced for spare organs and sold in commercial laboratories
hidden from public view. The possible serial production of human embryos could
lead to commercialization, thus opening the door to eugenic practices. 16 Embryos
could be selected on the basis of various characteristics, such as physical appear-
ance, sex or other genetic factors. They could be used for research without the
permission of donors. In the near future we could possibly see advertisements
for prospective donors or cloning contract announcements by companies.
l Does it come as a surprise that some are looking forward to the possibility of
creating banks of cloned human embryos, and cells and tissues derived from
them, as a resource for people who can pay for bodily enhancement? 35
The choice of whom to clone also raises concerns. Individuals who are consid-
ered to possess desirable characteristics, such as genius, and media stars or
athletes, could be selected for cloning with the aim of improving human beings.
Owing to the cost of cloning, only those people who have the ability to pay or
are members of favoured social groups will have access to this technology.9,15
l What about people who are thought to possess undesirable characteristics (e.g.
homosexuality, alcoholism, criminality) and diseased or disabled persons who
are thought to be ‘genetically inferior ’?
l Is there a danger of creating a ‘super-race’, with the Nazi experiments still in
living memory?36

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Discrimination and violation of human rights would be inevitable and wide-

spread. Supporters of human cloning could argue that all of these concerns are
illogical, speculative or imaginary. However, these matters are disturbing and
uneasy, and must be vigorously debated and investigated without prejudice.
Another concern is the potential harm to familial relationships. The family unit
would become different with the introduction of cloning.9,14
l What would be the consequences for a family if a man cloned himself?
l Would the child be that man’s son or his twin brother?
l Suppose a family want to clone their deceased loved child.
l Will the new child replace his or her brother or sister?
l How?
l Would the clone not resent this?
The family is the smallest unit of a society, and there are always reciprocal and
dynamic interactions between families and society. All factors that influence the
family unit and its relationships will therefore also affect society. It has been
claimed that, by intercultural marriage and coupling, certain culture-specific
diseases (such as thalassaemia) are slowly being eliminated. Some believe that,
with cloning, parental efforts at enhancing children’s capacities will intensify
because of the available knowledge regarding the child’s genetic structure. The
cloning of humans will thus not simply be about having children, but about
having a unique opportunity to improve on a desired specimen by investing in
enhanced genes and/or an enhanced environment.37
l Can human cloning offer a new method for human control and self-improve-
ment, by allowing families or society to have children free of specific genetic
diseases?
l Would cloning create new problems for societal health that may render life
generally more difficult?
If we consider the implications of human cloning for the general population
we can imagine other consequences. Cloning is not only a reproductive but also
a regenerative technique. Cloning technology holds the potential for using
people’s own cells to produce stem cells that can become replacement tissues or
organs. With such a potential, and by combining the cloning technology with
other advances in genetics such as gene therapy, the onset of diseases associated
with ageing could be prevented; ageing could be delayed, and rejuvenation
and/or an extended human life could become possible. As a result, although a
small percentage of the world’s population, probably those who are thought to
be favoured or who can pay, would enjoy a high-quality long life, but billions of
people would continue to struggle to survive. The gap between poor and rich
would continue to increase. We are living in a world where millions of people
are dying because of hunger and poverty. According to the World Health
Organization, 38 about 20% of the world’s population, or 1300 million people, live
in absolute poverty with an income of less than US$1 per day. Those living in
absolute poverty are five times more likely to die before reaching the age of five
years. Providing basic health services such as clean drinking water, adequate food,
sanitation, essential drugs, immunization and family planning could prevent the
vast majority of these deaths; there is no need for advanced and expensive tech-

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nology to provide these basic services. On these terms, human cloning also has
the potential to increase the social and economic inequities in the world, which
contradicts the notion of justice for all.
l Is it right to invest vast sums of money in practices that at best benefit only
very few people?36
l What may be the claim of the poverty of the majority of people in the world
on the minority that are well off?
l Does such a claim exist?
l How realistic would it be for poor people and countries to demand a share of
the (seemingly unnecessary) wealth of the few?

Potential harm to the gene pool

Evolution relies on a continual mixing and matching of genes to keep the gene
pool alive. 15 Sexual reproduction promotes genetic variability through combining
favourable mutations at different gene loci.39 A recent study by Rice and
Chippindale of experimental populations of Drosophila melanogaster (fruit fly)
demonstrated that the realized strength of selection on new mutations was
markedly increased when sexual recombination was present.40 Over time the new
genetic combinations enabled the species to respond to changing environmental
conditions through the selective survival of adaptable genotypes. The lack of
recombination could decrease genetic variability and impede adaptive
evolution.41,42 Human cloning separates reproduction from recombination
because there is no reshuffling of the genes. The cloned embryo contains DNA
that is an asexual replication of a single genome rather than the combination of
two parental genomes.37,39 If cloning became widespread, human genetic diver-
sity would decrease, the natural process of selection of genes would be bypassed,
and evolution would be impaired. 9,15,41
The CEJA stresses another serious point in its report9:
Since the somatic cell from which clones originate likely will have acquired mutations,
serial cloning would compound the accumulation that occurs in somatic cells. Although
these mutations might not be apparent at the time of cloning, genetic problems could
become exacerbated in future generations.
Miller also touched on this point and noted:
Germ cells, or gametes, undergo one act of splitting, and then are ready for recombi-
nation with another germ cell. But somatic cells divide constantly throughout life, and
each time their chromosomes split for replication and cell division, there is a high prob-
ability of mistakes in replication. They are not evolved for reproductive purposes. In
human cloning, the somatic cells are combined with germ cells and most gametic genes’
deleterious mutations would be masked. Therefore we cannot know whether the adult
somatic cells will be fit for several generations of reproduction.42
In accordance with these statements, it is obvious that the long-term conse-
quences of human cloning could be undesirable for the human gene pool and
evolution.
It should be noted that there are as yet no data about the potential physical
and psychosocial harm of human cloning for human health. At this time we do
not know its impact on the human gene pool; we can only make estimations and

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express our concerns. The concerns expressed here are, however, serious, and
need to be evaluated further, even if they are speculative.

Nursing implications
Cloning as a reproductive procedural mechanism is not a nursing function per se;
neither are nurses involved, as nurses, in this procedure. At this time it is an
experimental genetic-biological procedure. Thus, as yet, individuals and families
do not require nursing care and cloning is not a nurse’s primary responsibility.43
If we consider human cloning simply as an experimental procedure, nurses are
not involved at all. However, human cloning would affect every aspect of human
life, including the physiological and psychosocial dimensions, and the meaning
and value of life. Nursing as a profession is centred on human well-being, and
nurses deal directly with the life and health of individuals. Human cloning is
therefore a matter for nursing because of its relationships with the humanistic
values that are also the basis of nursing.
Humanism is a philosophical perspective centred upon the needs and interests
of human beings. It stresses the uniqueness and dignity of the individual person.
According to Antrobus,44 humanism includes: the nurturing response of one
person to another in need; viewing the individual as a whole; an emphasis on the
individual’s own perspective; developing human potential to its utmost; having
as a goal the well-being of others; and the nurse–patient relationship at the heart
of the helping situation. Antrobus describes the concept of caring as being inex-
tricably bound up with humanistic values and the practice of nursing. Caring is
the essence of the nursing profession; it includes recognizing individuals as
human beings of value and worth, and having needs. A range of theories have
been presented in the literature, which have caring as a central concept and are
based on a human science perspective. McCance et al.45 explored and presented
a comparison of four caring theories in their article on Leininger, Watson, Roach,
and Boykin and Schoenhofer. They concluded that these theories are grounded in
humanism and that the descriptions of caring and the definitions of nursing reflect
the humanistic nature of nursing.
Humanistic values can be regarded as cornerstones of ethical principles because
they are what we praise and hold in high esteem, what we feel deeply about what
is right; they are just and good for human life and human welfare. Human cloning
would bring the genetic inheritance of some people within human control,
creating individuals not simply for their value as persons, but for their particu-
lar genetic make-up. Human cloning has a predictive and determinative nature
because it has the potential to make genetic inheritance the criteria by which to
determine the importance and value of human life. This feature violates the right
to one’s unique genetic identity and dignity, and is therefore contrary to
humanism and nursing humanistic values.
Humanistic values give meaning to life. The way in which we care for others
depends largely on how we value (human) life and living. If we value life as good
in itself, we will want to be sure that we are not killed and that others will not
be killed. 46 Likewise, we will want to ensure that no human beings will be
harmed. Tschudin states that nurses are concerned with preserving and enhanc-

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ing human life, not destroying it.36 Although Tschudin is writing about abortion,
I think the same perspective is valid for the status of human embryos and fetuses
in human cloning, and that enhancement of human life does not imply eugenics
or using hybrids for xenotransplantation or for other purposes. With the line
between human beings and animals confused by hybrids, and with living in a
world where discriminations and inequalities would continue to increase by
human cloning, we may have to reconsider our values and start to think about
the answers to many questions.
l What is the worth of a human life?
l What are our ethical obligations toward potential human beings?
l What would be our responsibilities and duties toward a hybrid, a creature
with a human or partially human dignity, but who is not fully capable of pos-
sessing human dignity?
l Does it have self-determination or decision-making capacity?
l What rights will it possess?
l How could this challenge the humanism and practice of nursing?
Human cloning would have an effect on nursing practice because it may result
in the creation of new physiological and psychosocial conditions (for the cloned
child, for the family and for society) that will require nursing care. In this respect,
nurses will have to address the implications of human cloning for nursing practice
and to consider the potential roles of nurses.

Potential roles of nurses

Nurses’ potential roles are hypothetical and probably insufficient because the
future may be different and stranger than we can imagine. Nevertheless, the
ethical and health related concerns of human cloning provide clues for the future,
so we can indeed consider the potential roles and responsibilities of nurses.

A protector and advocate role

As an experimental procedure, the safety of human cloning is untested and the
consequences of this procedure are unknown. There are potential physical and
psychosocial harms for individuals, and there is the potential to increase the dis-
criminations and inequalities of our world. As professionals, nurses must empha-
size respect for persons, their dignity, individuality and worth, and they must
enquire into any harm to human beings. Nurses must provide essential health
care services regardless of genetic background, physical condition, or social or
economic status, and they must ensure equitable access to scarce resources, in par-
ticular for economically poor people. However, justice for all in health care is not
in our hands alone. It is well known that the economic and political conditions
of a country and also international and regional disparities in the distribution of
health services affect the rights and opportunities of people for access to health
care. Protection of human rights and justice requires legal regulations based on
ethical principles. Nurses are important members of the health care team. They
have a power to influence health care politics and public debate. In my opinion,
at this time, the most important role of nurses is as protector and client advocate.
The humanistic nature of nursing provides the basis for this role. Patient advocacy

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250 L Dinç

is also a requirement of beneficence and is included in many codes of ethics for

nurses; it is therefore also a professional and an ethical duty. One ethical duty is
to be politically aware and active. In the role of client advocate, individual nurses
can protect human and legal rights by contributing to the discussions, politics and
policies surrounding human cloning. In order to contribute to health care politics
and to enhance their interest, they can also use the media to communicate with
the public; they can write health columns for regional newspapers or publish in
nursing and non-nursing journals. The vehicle for collective and effective action
is usually a professional organization. International and national nursing associ-
ations should be involved in ethics and policy boards, and in committees that
investigate the implications of human cloning for human health. They should
speak out against the policies and politics that endanger human life and health.
An important component of this role is to ensure that individuals and the whole
of society have been given adequate information about cloning in a way that they
can readily comprehend.

A caregiver role
Advanced diagnostic and therapeutic methods such as for genetic screening, gene
therapies, in-vitro fertilization techniques, and the use of ventilators, are some-
times double-edged swords because they have both positive and negative conse-
quences for individuals. Nurses are responsible for the care of people who are
left with the health consequences of such developments, and they often confront
situations that require ethical decision making. Recent animal cloning experiments
have revealed developmental abnormalities in the clones. This indicates that
similar abnormalities would probably occur if human cloning is used. There
would probably be an increased risk of birth defects in children brought to term.
Paediatric nurses may then be required to care for these children from the neonatal
period through to adolescence. Providing care for them and their families can
include meeting their physiological and psychological care needs. In order to
provide high-quality care for these children, nurses would need a comprehensive
understanding and knowledge of physiology, pathology, and, in particular, the
genetic basis of developmental abnormalities. The birth of an infant with a devel-
opmental disorder can be a devastating experience for a family. The parents may
feel guilty and responsible for the situation, and the resulting depression can affect
their role as a mother or father. Even with a mild abnormality, such children can
become so dependent on their parents that they do not have the opportunity to
learn the skills necessary for adjustment to life. On the other hand, children who
know that they are cloned individuals may experience an identity crisis. Nurses
could help these children and their parents by establishing trusting relationships,
conveying acceptance and respect. They can use effective communication to assess
a child’s sense of self and also encourage discussion of the thoughts and feelings
of the whole family.

A counselling role
The likely impact of human cloning on health is complex and, with scientific
and technological developments, more sophisticated and advanced methods of
diagnosis and treatments would become available. Professionals who are experts
in different areas would provide health care. Nurses cannot make decisions in

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 Ethical issues regarding human cloning 251

isolation from other health team members, so they must recognize the importance
of interprofessional collaboration. In community clinics, as well as in hospital
settings, nurses will undoubtedly encounter couples or individuals who raise
questions about cloning. They therefore need to be able to play an important role
in helping these people through the decision-making process about cloning and
its implications by co-ordinating and integrating services. They can help these
individuals by referring them to the available resources and experts.
Nurses could also provide counselling for individuals or couples who seek
information about cloning or who prefer to have a biological child by this pro-
cedure. Counselling skills are a specific type of communication that some people
use with expertise.46 A study by TerziogÆ lu47 demonstrated that the anxiety and
depression levels of couples who applied for assisted reproduction techniques
were decreased when effective counselling was provided. Counselling for indi-
viduals regarding human cloning could include the following: providing correct
and up-to-date information about the cloning procedure, the time, cost and effort
required for this process, and the potential benefits and harms; explaining the
meaning of their potential child’s genetic condition; informing them about the
genetic tests that can be performed to determine any developmental abnormality
during a pregnancy; discussing the effects of cloning on a child’s psychological
development and on familial relationships; and clarifying their personal values.
The most important component of counselling is to support the individuals
regardless of their decisions. Nurses should be aware of their individual and pro-
fessional values, but they should not rely on their own values or concerns about
cloning and must be neutral in the counselling process. However, this may be
very difficult because our values influence our attitudes and actions. In addition,
nurses who have had no training and who have no supervision run the greatest
risks of being ineffective or unconsciously incompetent.45 Therefore nurses would
need to be well trained in counselling, well supervised in their practice, and also
well motivated and always well informed of any developments in the fields of
both counselling and genetics (V Tschudin, personal communication, 2002).

As nurse educators
The need for the preparation of nurses to be able to understand genetics and the
implications of human cloning for the well-being of people is obvious and urgent.
Human cloning is almost certainly impossible to stop and the scientific data will
accumulate. This demonstrates the necessity of incorporating the relevant infor-
mation into nursing education. Nurse educators should include the current infor-
mation about genetics and human cloning into the curriculum in order to prepare
nurses for this new challenge. The need for genetics to be an integral part of
nursing educational programmes has been expressed by many authors.48,49
However, the nursing literature shows a lack of or limited incorporation of
genetics as part of basic nursing education programmes. A study conducted in
the USA demonstrated that, among the nursing programmes surveyed, the mean
number of hours in the curriculum devoted to genetics topics was 6.2. 50 Another
study revealed that genetics is taught for 10 hours or less on most courses of
diploma-level training programmes for nurses in the UK. In this study the
majority of respondents (81%) agreed that genetics will have a major impact on
health care, and will become an increasingly important issue in nurse education.51

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252 L Dinç

The nursing profession will also need to incorporate genetics into continuing edu-
cation programmes. A survey of 68 nursing specialty organizations reported that
only 30% of administrators were planning to offer genetics content in future pro-
grammes.52 These findings suggest that there is a need for the incorporation and
dissemination of genetics in clinical practice and education. In the nursing liter-
ature no studies or surveys can be identified regarding the status of human
cloning in educational programmes for nurses.
Consideration and guidance by international and national nursing organiza-
tions regarding human cloning are necessary to provide insight into this subject
for nurse educators and clinical nurses. Professional nursing associations must
assume the responsibility for offering educational programmes, workshops and
seminars that focus on the implications of cloning for human health. These orga-
nizations need to provide help in clarifying nurses’ expanding roles.
As nurse researchers
There are no empirical data available about the impact of human cloning on indi-
vidual health and on nursing. At this time we do not know how human cloning
may affect nursing care. There will be many problems to be investigated by nurse
researchers, including the impact of cloning on an individual’s life and health, the
potential nursing roles and functions, and the viewpoints of nurses regarding this
issue. Research on these topics will provide the knowledge base required to guide
clinical practice and expand the scope of nursing practice. Nursing research will
also strengthen the position of nurses as members of the health care team and
will facilitate the contribution and development of policies on this subject.

Conclusion
In conclusion, nurses cannot say human cloning has nothing to do with nursing.
They cannot close their eyes to its potential problems, because they are part of
society and part of this world family. Furthermore, nurses are an important part
of health care teams and they will be faced with the health consequences of human
cloning for individuals, for families and the whole of society, for whom they are
responsible. Nurses should therefore ask themselves several questions:
l Who will care for babies with developmental abnormalities and who will care
for possible hybrid creatures?
l What are our professional values and ethical obligations towards individuals,
society and toward the future of human beings?
l How can/could/should we deal with the consequences of human cloning?

Acknowledgements
I would like to thank Verena Tschudin for her helpful comments and ideas during
the development of this article. Without her encouragement it would never have
been written. I would also like to thank the two anonymous reviewers for their
helpful comments and suggestion, and Geoffrey Hunt who helped me by allowing
me to read his article.

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 Ethical issues regarding human cloning 253

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